Ketamine-Assisted Psychotherapy  101                                      

Interested in learning about ketamine and ketamine-assisted psychotherapy?

Below, you'll find many answers to your questions about what ketamine is, what it feels like, how it can help you, the process of the sessions and the costs.

What is Ketamine?

Ketamine is a legal, safe, and effective medicine used to treat a variety of mental health conditions, including depression, anxiety, and PTSD. Ketamine has a long history of safe use as an anesthetic in a medical setting, due to its lack of respiratory suppressing effects. Ongoing research shows ketamine produces rapidly acting antidepressant and mood-enhancing effects, which can begin to take effect within 1-2 hrs. after treatment. It works by blocking the brain’s NMDA receptors as well as by stimulating AMPA receptors, which are thought to help form new synaptic connections and boost neural circuits that regulate stress and mood. Ketamine has also been shown to enhance overall neuroplasticity for more sustained symptom improvement.                                                                                                                                                     Ketamine can be administered in a variety of ways, including IV infusion, intramuscular (IM) injection, via nasal spray and using sublingual/oral lozenges - sometimes referred to as troches. For your sessions, we will use sublingual/oral lozenges, prescribed to you by a psychiatrist or MD.

How Does Ketamine Feel?

The effects of ketamine, which most patients find pleasant, last for approximately 45 to 90 minutes. These effects can make you feel “far from” your body and facilitate shifts in perception that can often feel expansive in nature.

Ketamine often softens defenses, allowing for deeper access to traumas and subconscious material in need of healing. People report a variety of insights and experiences, such as feeling outside of the self, seeing things from a different perspective, or feeling a sense of oneness--what would be termed a “mystical” or spiritual experience. We are trusting the medicine and your inner healing wisdom to bring up what you need in the moment - what needs to arise will arise.

Ketamine’s antidepressant effects are cumulative, so you may find that you achieve the most benefits with 4-8 session

Why use Ketamine in the Context of Therapy?

Taking ketamine in a therapy session makes sense because the material and insights that emerge may be related to relationships, spirituality, traumatic memories, symptoms of anxiety, depression and ptsd. Your therapist can help you understand, integrate and process that information during and after your ketamine journey.

Who Should not Take Ketamine? People with:

• Untreated high blood pressure
• Addiction to ketamine
• Untreated mania
• Schizophrenia, psychosis

Common Experiences During a Ketamine Treatment Session:

Dissociation: A sense of detachment from one’s body, emotions, or surroundings. Some people may experience a feeling of floating, or an altered perception of time and space.

Altered perceptions: Colors may appear more vibrant or muted, sounds may be amplified or muffled, and physical sensations may feel more intense or muted.

Visual and auditory hallucinations: Ketamine can cause vivid and sometimes intense hallucinations, such as seeing geometric patterns, or hearing sounds or voices.

Emotional experiences: Ketamine can evoke a range of emotions, including euphoria, tranquility, compassion, sadness, fear and grief. Some people may feel like they have gained a new perspective on their emotions or experiences, or they may experience a sense of connection with others or the universe. You may also feel confused by some of your experiences, which is where the importance of integration comes in.

The Roadmap of Your Ketamine-Assisted Psychotherapy (KAP) Sessions:

I partner with an organization called Journey Clinical (JC), who provides medical support and the ketamine prescription, while I take on the therapy piece of your treatment. You also have the option to ask your own psychiatrist to prescribe ketamine for your KAP sessions.

After you have been approved for a ketamine prescription through JC or your own psychiatrist and complete a psychotherapy intake with me (if you are a new client), at least 2-3 preparation sessions are held before your 3-hour ketamine session. In these sessions we will discuss your hopes, fears, and expectations for your ketamine session. We will also discuss set and setting for your experience, talk about your intentions, develop affirmations, discuss challenging emotions, build grounding and calming skills, and plan for integration.

During the ketamine session itself, you will take your own vitals with my blood pressure cuff so we can make sure your blood pressure is within a normal range. You’ll settle into my reclining couch with a cozy blanket as we talk about your goals and intentions, and you will then take the ketamine lozenge, swishing it in your mouth for 10-12 minutes without swallowing. The taste is bitter and your mouth will feel numb, and I will support you through this by playing soothing music, leading you through a guided meditation, and reminding you of your affirmations and intentions. You may notice that the effects of the ketamine come on quickly, with a sensation of light-headedness or dizziness.

After the swishing, you’ll spit out the ketamine and relax on the couch with eye shades on, listening to carefully chosen music as you sink into the experience. Many people are silent during their journey, while some people choose to talk about what they are experiencing--both are completely fine! While you are on your journey, my role is to hold space for you, providing an emotionally supporting presence as I sit in silence with you and/or listen to you.

Once the effects of ketamine subside, we’ll spend the remainder of our appointment giving you space to integrate, process, and discuss your experience. The integration portion of the session is important because it gives us a chance to pull together the insights and themes of your experience and talk about how you can use them in your daily life. Together we will work to understand your experience on a deep level so that you can continue to work towards developing healthier habits and beliefs about yourself and others.

After your session, you may be hungry and thirsty, and I’ll have some snacks and water/tea/hot cocoa for you. By the end of the session, you should feel back to your usual self, though you may feel somewhat spacey and tired. For these reasons, it’s important to have a trusted person pick you up to bring you home, and you shouldn’t drive for at least 6 hours after ingesting the ketamine. We will have a chance for further processing in your next integration/ketamine preparation session.

What’s the Cost of KAP?

I charge a low, flat rate of 150.00/hour, so ketamine assisted psychotherapy sessions are typically 450.00, while the intake, preparation and integration sessions are typically 150.00.

You’ll also need to pay the co-pay or out-of-pocket fee for your psychiatrist, as well as the fee for the ketamine itself.

Can I use my Insurance?

Yes and no. Unfortunately, insurance does not cover sessions longer than an hour and does not allow for partial billing, so you’ll be paying out-of-pocket for your 3-hour ketamine session. You may be able to use insurance to cover your intake, preparation and integration sessions, however. Be sure to ask if I can accept your insurance.

How Many Sessions Should I Have?

Since ketamine has a cumulative effect, it’s recommended that you have a total of around 4-8 sessions for maximum benefit. Your psychiatrist will help you determine how to space your sessions and which dosage will be best for you. If you are a new client without another therapist, we'll meet for at least 3, 55-min. sessions before your ketamine session (for intake, rapport building, preparation, psycho-education and resourcing). If you already have a therapist, we can meet for 2 sessions before your ketamine session. I ask that you commit to at least 3 ketamine sessions, however you are always free to stop at any time.

So to summarize, the process might look something like this:

1. Intake with therapist, who will refer you to psychiatrist.

2. Psychiatrist intake and assessment, ketamine prescription sent to you or you pick it up.

3. Preparation sessions with therapist (2 or 3).

4. Ketamine session.

5. Integration session/prep for next katamine session.

6. Ketamine session.

7. Rinse and repeat till you feel better!

Contact me for a complementary, in-person or virtual consultation to determine if KAP may be a good fit for you at m.young@creativejourneyscounseling.com.